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- Over 30 Laboratory Groups Demand CMS Cover NGS Testing for Patients
The CAP and over 30 other medical laboratory health organizations asked the CMS not to remove over 100 diagnostic codes from national coverage determination for Next-Generation Sequencing (NGS) as it will impact critical patient care. The CAP had advocated for NGS Medicare coverage for patients with advanced cancer.
In the April 6 letter, the groups outlined how removing these codes will also remove critical coverage for “genomic testing for a significant number of patients with advanced cancer and likely result in tens of thousands of inappropriately denied Medicare Part B and Part C claims.”
In 2018, the CMS finalized the national coverage for NGS-based genetic testing for patients with advanced cancer, enabling access to comprehensive genetic testing for cancer treatments. NGS-based testing has become a valuable tool in cancer treatment protocols.
However, in the final 2022 In-Patient Payment System regulation, the CMS left out numerous cancer ICD-10 NGS codes from designation changes to not discourage their use in the in-patient setting. The CMS created confusion for coverage of Medicare cancer patients, delaying critical life-saving care.
The CAP will remain engaged with the CMS on this coverage issue.